Changes in height, weight and plasma leptin after bone marrow transplantation

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Short stature and gonad failure can be a side effect of total body irradiation (TBI). The purpose of the study was to evaluate the factors influencing final height and gonad function after TBI. Fifty young adults given TBI during childhood were included. Twenty-seven had been treated with growth hormone (GH). Those given single 10 Grays (Gy) or fractionated 12 Gy TBI had similar characteristics, GH peaks, final heights and gonad function. After the end of GH treatment, 11/20 patients evaluated had GH peak 410 lg/l. Final height was oÀ2 s.d. in 29 (58%). The height loss between TBI and final height (2.471.1 s.d.) was greater in those who were younger when irradiated (Po0.0001). When the GH-treated and -untreated patients were analyzed separately, this loss was correlated with the age at TBI at 4-8 years for the GHtreated and at 6-8 years for the untreated. Boys showed negative correlations between testicular volume and plasma follicle-stimulating hormone (FSH, P ¼ 0.0008) and between plasma FSH and inhibin B (P ¼ 0.005) concentrations. We concluded that the indications for GH treatment should be mainly based on the age at irradiation, taking into account the GH peak. The plasma FSH and inhibin B concentrations may predict sperm function.

Section: Discussionmentioning

confidence: 99%

Final height and gonad function after total body irradiation during childhood

Couto-Silva

Trivin

Esperou

et al. 2006

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“…Hypothalamic-pituitary function was assessed in those given TBI, and plasma thyroid stimulating hormone in those given TBI or TLI. 6 Associated growth hormone deficiency was found in 29 patients (20 boys), among them, 28 had been treated with growth hormone. Associated thyroid deficiency was found in 31 patients (21 boys), who had been treated with thyroxin.…”

Section: Methodsmentioning

confidence: 99%

“…The chemotherapy protocol was as previously reported. 6 Chemotherapy was given before BMT in cases 1-22, 33 …”

Section: Patientsmentioning

confidence: 99%

Factors affecting gonadal function after bone marrow transplantation during childhood

Couto-Silva

Trivin

Thibaud

et al. 2001

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Summary:Conditioning for bone marrow transplantation (BMT) may alter viability of germ cells and production of gonadal hormones. We analyzed the risk factors for gonadal failure after 12 Gy total body irradiation (TBI) given as six fractions (n = 31, group 1), 10 Gy (one dose) TBI (n = 20, group 2), 6 Gy (one dose) total lymphoid irradiation (TLI, n = 17, group 3) and chemotherapy alone (n = 7, group 4), given at 7.7 ± 0.4 (0.6-13.6) years. Among the 34 girls, seven (20.6%) had normal ovarian function with regular spontaneous menstruation and normal plasma follicle-stimulating (FSH) and luteinizing (LH) hormones, five (14.7%) had partial ovarian failure with regular menstruation but increased FSH and/or LH, and 22 (64.7%) had complete ovarian failure. The 24 girls with chronological and bone ages Ͼ13 years included similar percentages, with increased FSH or LH in all four groups. There was a positive correlation between age at BMT and FSH (r = 0.54, P Ͻ 0.01), but not with LH, and between FSH and LH (r = 0.8, P = 0.0003). Plasma FSH concentrations had returned to normal spontaneously in six cases, and those of LH in two cases. Among the 41 boys, 16 (39%) had normal testicular function and 25 (61%) had tubular failure and increased FSH. Of these, 10 also had Leydig cell failure (three complete and seven partial). The 18 boys with chronological and bone ages Ͼ15 years included similar percentages with increased FSH or LH in groups 1 to 3, and testicular volume was significantly lower in group 2 than in group 3 (P = 0.008). There was no correlation between age at BMT and FSH, LH or testosterone, but there was a negative correlation between FSH and inhibin B (rho = −0.87, P Ͻ 0.003). We conclude that girls are more likely to suffer ovarian failure the older they are at BMT, and that early ovarian recovery is possible. Keywords: bone marrow transplantation; fertility; inhibin; irradiation; ovary; testis Conditioning for bone marrow transplantation (BMT) may alter the production of gonadal hormones (estradiol and progesterone in girls, testosterone in boys) and the viability of germ cells. 1-3 Gonadal failure results in incomplete sexual development and growth at puberty, and sterility in adulthood. Gonadal hormones are required for the development of secondary sexual characteristics, and for the growth acceleration which normally occurs at puberty.The risk factors for gonadal failure in patients undergoing BMT are difficult to analyze because of the variety of conditioning regimens used, and the possibility of gonadal recovery. 4 This study analyzes the expression and frequency of gonadal failure in both sexes according to the conditioning protocol, and the significance of the age during childhood at which BMT is carried out. We also measured plasma inhibin B concentrations as an additional marker of tubular function in these young patients where semen analysis is not possible. PatientsThe gonadal function of 75 patients (34 girls and 41 boys) who received a BMT during childhood, and who were aged more than 10 years ...

“…Nyson et al 32 found that cranial irradiation leads to muscle loss and body fat in children. Couto-Silva et al 33 found that children with TBI had lower BMIs at 2 and 5 years post-HSCT than patients who were not treated with TBI. TBI might have contributed to low LBMI reported in this study, since 94% of our patients received pre-HSCT TBI.…”

Section: Effects Of Treatmentmentioning

confidence: 99%

Longitudinal follow-up of body composition in hematopoietic stem cell transplant patients

Kyle

Chalandon

Miralbell

et al. 2005

Summary:Patients with hematological malignancies are well nourished prior to allogeneic hematopoietic stem cell transplantation (HSCT). HSCT and associated complications can affect body composition. The study evaluated crosssectionally the prevalence and longitudinally the changes in lean body mass index (LBMI) in HSCT patients. Patients (n ¼ 82) were classified as normal or low LBMI. Logistic regression analyses were used to estimate odds ratios (OR) for low vs normal LBMI, between healthy volunteers and patients; for limited or extensive vs no chronic graft-versus-host-disease (GVHD); and for decreased (Karnofsky o80) vs normal functional status (480). Patients were significantly more likely to have low LBMI at 6, 12 months, 2-3, 4-6 and 46 years than volunteers. In all, 38% of patients were below pre-HSCT LBMI at 4-6 years post-HSCT. Low LBMI was significantly associated with steroid treatment (OR 2.6, confidence intervals (CI) 1.3-5.2, P ¼ 0.008); limited (OR 5.5, CI 1.7-18.5, P ¼ 0.005) or extensive chronic GVHD (OR 20.3,, Po0.001); and decreased performance status (Karnofsky scores of p80) (OR 2.7, CI 1.3-5.9, P ¼ 0.01). Patients were more likely to have low LBMI than volunteers. Chronic GVHD and low performance status were associated with low LBMI; thus, complications and/or treatment increase the likelihood of low LBMI. Patients with hematological malignancies are usually well nourished at the time of allogeneic hematopoietic stem cell transplantation (HSCT). 1,2 However, nutritional consequences after HSCT have not been well studied. Underweight patients are at increased risk of death in the early post-HSCT period, and nonrelapse mortality is greater for extremely underweight or overweight patients. 3,4 High body mass index (BMI), weight normalized for height, may also affect treatment-related toxicity and mortality. 5 Furthermore, low lean body mass (LBM) has been associated with poor outcome and increased length of hospital stay. 6 Allogeneic HSCT and associated complications, including infections and graft-versus-host-disease (GVHD), can affect body weight and body composition. Immunosuppressive therapy after transplantation has been shown to alter skeletal muscle metabolism. 7 Corticosteroids promote muscle atrophy by increasing the rate of protein catabolism, amino-acid efflux, while simultaneously decreasing the rate of protein synthesis. 8 Thus, treatment and complications following HSCT exert profound negative effects on LBM.As low LBM is associated with poor outcome, the evaluation of LBM and body fat changes in pre-and post-HSCT patients can aid in adapting nutrition policy, for example, nutrition support in malnutrition and food restriction in obesity. 9 Just as BMI is useful in evaluating the excess or deficit in body weight in individuals of different heights, the lean body mass index (LBMI, kg/m 2 ) and body fat mass index (BFMI, kg/m 2 ) are potentially useful in evaluating body composition parameters by effectively eliminating differences in LBM and body fat with height. 10 Height-indepe...